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Biomedical subjects

J V Hamerlynck

Publications and source records attributed to J V Hamerlynck.

At least 19 recordsLinked to original sources
PubMed1999

Clinical outcome after unilateral oophorectomy in patients with polycystic ovary syndrome.

The objective of this study is to report retrospectively on the clinical outcome of unilateral oophorectomy in 14 women with polycystic ovary syndrome who had undergone this treatment 14-18 years ago in our hospital for clomiphene citrate-resistant anovulation and long standing infertility or for severe hirsutism. The main outcome measures were menstrual cycle, pregnancy, hirsutism, testosterone concentrations, and premature ovarian failure. Unilateral oophorectomy restored regular menstrual cycles in 12 of the 14 patients. Thirteen years later, nine out of 12 patients still had regular menstrual cycles. Ten patients wished to become pregnant. Seven of them conceived spontaneously. Eleven patients complained of severe hirsutism. After unilateral oophorectomy, hirsutism regressed subjectively in six. Testosterone blood concentrations decreased significantly within the first year after unilateral oophorectomy in 11 patients. None of the women entered menopause within 14-18 years after surgery. Our results indicate that unilateral oophorectomy restores ovulatory function for many years in the majority of patients and does not result in premature ovarian failure. However, unilateral oophorectomy should not be recommended as a standard treatment for clomiphene citrate-resistant patients with polycystic ovary syndrome.

Adult↗
PubMed1998

[The family practitioner and the postcoital test].

There is still a great deal of controversy on the value of the postcoital test. Some consider it to be a valuable method for the general practitioner to evaluate the interaction in vivo between spermatozoa and cervical mucus, in spite of the poor predictive value of the test. The postcoital test is in fact only an indirect method for the detection of the production of moving sperms. As a negative postcoital test is frequently due to bad timing of the test, multiple mandatory intercourse is often necessary, which may lead to frustration and sexual dysfunction. Moreover, there are no indications that the postcoital test with its poor discriminatory power may be better in general practice than the fertility evaluations by a specialist as standardisation and reproducibility problems are equal in both settings. Therefore semen analysis appears to be a better option, for the general practitioner as well.

Family Practice↗
PubMed1998

[Last word on hormone replacement and breast cancer?].

A very large meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer has revealed an increasing risk of breast cancer with longer durations of use of hormonal replacement therapy (HRT). This risk increase is restricted to current users of HRT or women who ceased use recently. A 35% increase of the relative risk of breast cancer was found after 5 years of HRT use or longer. After cessation of HRT use the excess breast cancer risk disappeared in 5 years, even after long durations of use. The risk increase was greater for women of normal or lean body weight than for more obese women. Tumours found in women who ever used HRT were diagnosed at a lower clinical stage, which suggests that enhanced screening might be involved. However, the increased breast cancer mortality in HRT users, as found in other studies, rather suggests a biologic mechanism Long-term use of HRT is not yet common in the Netherlands, but an increasing trend is present. Thus, the benefits of long-term use of HRT must be carefully weighted against the risks.

Aged↗
PubMed1997

Unilateral oophorectomy in polycystic ovary syndrome: a treatment option in highly selected cases?

We performed unilateral oophorectomy (UO) in three patients with polycystic ovary syndrome (PCOS) and long-standing infertility. The indication for performing this procedure was a combination of ovarian pathology and the long-standing infertility. All three patients were resistant to clomiphene citrate and before UO all patients had been treated unsuccessfully with gonadotrophins and in-vitro fertilization. All three patients became ovulatory within the first month after UO. Two patients conceived 11 and 12 months after surgery respectively and delivered healthy babies. Testosterone concentrations decreased in two patients to upper values of the normal range and remained unchanged in one patient. We conclude that restoration of ovulation can be a beneficial side-effect of UO in clomiphene citrate resistant patients with PCOS and long-standing infertility.

Adult↗
PubMed1995

Suspected ectopic pregnancy. What to do when human chorionic gonadotropin levels are below the discriminatory zone.

OBJECTIVE: To assess the value of a noninvasive diagnostic strategy in cases of suspected ectopic pregnancy when transvaginal sonography (TVS) and serum human chorionic gonadotropin (hCG) measurement show inconclusive findings. STUDY DESIGN: Prospective study of 85 patients without pregnancy detectable on initial TVS together with low hCG levels (< 1,500 IU/L). The diagnostic strategy combined the results of TVS, hCG measurements and time, according to a strict algorithm. RESULTS: Overall test results of the strategy were excellent: sensitivity, 0.94; specificity, 1.00; likelihood ratio of a positive test result, infinity; likelihood ratio of a negative test result, 0.06. The strategy revealed a new diagnostic entity, trophoblast in regression (TIR). TIR represents patients with declining hCG levels and unknown locations of their pregnancies, presenting a benign clinical picture, and constituted 54% of the population studied. CONCLUSION: This noninvasive diagnostic strategy proved to be very reliable. Because the strategy integrated expectant management of patients with declining hCG levels, it prevented many unnecessary surgical procedures. This was of great benefit for both patients with early intrauterine pregnancies and those with TIR.

Algorithms↗
PubMed1993

Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?

Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the diagnostic value of an algorithm, combining transvaginal sonography with an HCG cut-off level between 1000 and 1500 IU/l (IRP) was tested in 208 consecutive women at risk for ectopic pregnancy. Three diagnostic categories are designated by the algorithm: intra-uterine pregnancy (n = 73), ectopic pregnancy (n = 89), and trophoblast in regression (n = 46). The latter category represents patients in whom no pregnancy could be located by transvaginal sonography, with an initial HCG concentration < 1500 IU/l, declining during follow-up. The algorithm has a sensitivity of 0.97, a specificity of 0.95, a likelihood ratio for a positive test of 19.4, and a likelihood ratio for a negative test of 0.03. The described diagnostic strategy thus proved extremely reliable in the safe management of patients at risk for ectopic pregnancy, and renders laparoscopy obsolete.

Algorithms↗
PubMed1993

Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach.

In this prospective study among 208 high-risk patients with suspected ectopic pregnancy, the diagnostic value of transvaginal sonography and serum human chorionic gonadotrophin (HCG) measurements were analysed in detail. The absence of an intra-uterine gestational sac obviously was the most constant sonographic finding among patients with ectopic pregnancy (n = 89), with a very high sensitivity (0.99) but a low specificity (0.41). The application of different HCG cut-off levels improved specificity to 1.00 for values exceeding 4500 IU/l. Clinical utility obviously decreased, as many patients presented with HCG values well below this level. The additional effect of adnexal findings was analysed. Sonographic identification of an ectopic pregnancy was very specific (0.99) but had low sensitivity (0.56) because many ectopics were not detected. The additional effect of HCG values on these results was minor. The low HCG cut-off levels advocated in recent studies are questioned by the results of our analysis: whereas the combined use of sonography and HCG measurements is shown to be of great benefit, the limitations are also documented, underlining the need for re-evaluation at intervals of patients with low HCG values. The question of which cut-off level should be used in practice, however, hinges on a difficult choice between a certain specificity and clinical utility.

Adnexa Uteri↗
PubMed1990

[Norplant].

Explore the source record for details and available documents.

Adult↗
PubMed1988

Results of artificial insemination at home by the partner with cryopreserved donor semen: a randomized study.

The use of cryopreserved semen offers the possibility of home insemination by the instructed partner. A comparative study was designed whereby participants were randomly allocated to use home or clinic insemination for six cycles. If no pregnancy had occurred after six cycles, the site of insemination was switched to the opposite location for a maximum of six further cycles. Fifty-three women with primary infertility fulfilling all entry criteria entered the study. In the first 6 cycles out of 29 home starters, 13 pregnancies were conceived, whereas in 24 clinic starters 11 pregnancies occurred, yielding no statistical difference in pregnancy rate. Of 138 couples who did not meet the criteria in the same period, 45 opted for home insemination, resulting in 20 home-inseminated pregnancies. Again, for comparable subgroups no statistical difference in pregnancy rate between home and clinic insemination was found.

Evaluation Studies as Topic↗
PubMed1987

Postponement of withdrawal bleeding in women using low-dose combined oral contraceptives.

Postponement of menses is widely practised by women using oral contraceptives. One-hundred volunteers, consisting of three groups of women, each group using a different extensively used contraceptive regimen, were tested and compared. The test period consisted mainly of a double (monophasics) or extended (triphasics) pill cycle without a tablet-free interval. Based on daily records of vaginal bleedings as well as on the results of a questionnaire, it could be concluded that postponement of the withdrawal bleeding for twenty extra days was generally effective; the occurrence of the bleedings was related to the duration of postponement of menses and to the contraceptive regimen that was used. However, the introduction of a seven-week cycle pill is not yet a promising alternative since the majority of the volunteers preferred the inconvenience of a monthly withdrawal bleeding.

Adult↗